Update guidance, sort of, on whether to circumsize babies ...

Blog Post by: Jeremy Olson

August 27, 2012 - 12:26 PM

The American Academy of Pediatrics stopped short of recommending that all newborns be circumcised, but on Monday did encourage health insurers to pay for the controversial procedure. That conflicts with the current policy for Minnesota's Medicaid program, which since 2005 has mostly denied coverage of the procedure.

An expert panel reviewed medical research since 1995 on circumcision -- the surgical removal of the foreskin surrounding the penis -- and advised AAP that there is now stronger evidence in favor of it. (AAP had previously examined the medical evidence in 1999 and 2005, and was noncommittal.) The health benefits, according to AAP's press release on its new stance: "lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life."

The pros were weighed against the cons, including the cost and pain of any complications from the procedure, and the cost of providing the procedure in the first place. Opponents have also questioned the ethics of performing an involuntary, elective and potentially painful procedure on infants who can't consent to it. A separate study last week in the Archives of Pediatrics and Adolescent Medicine found that circumcisions -- despite the costs of the procedures themselves -- actually save money over time by reducing the risk of certain diseases.

There is disagreement over how many newborns in the U.S. are circumcised shortly after birth, but there is broad agreement that the rate is dropping. Almost four in five newborn boys were circumcised in the 1980s. Now, it's closer to 50-50. That is significant, as social factors often weigh on new parents as much as the medical ones. A 2010 Star Tribune story quoted one dad who chose a circumcision for his son so he would one day look like most of the other boys in a junior high locker room.

The Minnesota legislature voted in 2005 to drop coverage of circumcision from the state's Medicaid program for poor and disabled residents. The only exceptions were when the procedures were medically necessary or required by a family's long-standing religious practice. The religious exemption was removed from the state policy two years later, though. Minnesota is among 18 states that limit or ban coverage of circumcisions.

Bloomington psychologist Stefan Bailis was not involved with the AAP recommendation, but has co-authored a dozen published studies and articles that favor circumcision. In an email, he said Minnesota's ban on Medicaid coverage is problematic, because it reduces circumcisions among low-income residents who would benefit the most from it. The procedure reduces the risk of HIV transmission, he argued, and that disease is more prevalent in the state's low-income population.

"Part of (opponents') ideology is that the foreskin is not a mistake of nature," he argued. "I would simply say that the foreskin was probably useful millennia ago for protection against sharp rocks thorny bushes. The routine wearing of clothing has made it obsolete."

Obviously Bailis presents one side of an issue over which there remains disagreement. What are your thoughts? Did you chose circumcisions for your children? Why or why not? Reply in the comments below.